Suda Arnold J, Franke Axel, Hertwig Miriam, Gooßen Käthe
Centre for Orthopaedics and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim of Heidelberg University, Theodor-Kutzer-Ufer 1-3, 67168, Mannheim, Germany.
Department for Trauma Surgery and Orthopaedics, Reconstructive and Septic Surgery, Sportstraumatology, German Armed Forces Hospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany.
Eur J Trauma Emerg Surg. 2025 Jan 10;51(1):5. doi: 10.1007/s00068-024-02727-0.
Our aim was to generate evidence- and consensus-based recommendations for the management of mass casualty incidents (MCIs) based on current evidence. This guideline topic is part of the 2022 update of the German guideline on the treatment of patients with severe/multiple injuries.
MEDLINE and Embase were systematically searched to August 2021. Further literature reports were obtained from clinical experts. Randomised controlled trials, cross-sectional studies, prospective cohort studies, and comparative registry studies were included if they compared triage algorithms, interventions for MCI training, logistics or transport, decontamination, diagnosis or therapy during MCIs in the prehospital and hospital settings. We considered patient-relevant clinical outcomes such as mortality, diagnostic outcomes including sensitivity and specificity, rates of undertriage and overtriage as well as resource use. Risk of bias was assessed using NICE 2012 checklists. The evidence was synthesised narratively, and expert consensus was used to develop recommendations and determine their strength. Population, intervention, comparison, and outcome (PICO) questions from clinical questions were developed by clinical experts and guideline methodologists.
We screened 321 records in the original guideline version and 4225 during this update. Twenty-five studies were included, all of them from the updated search from 2009 to 2021. Twenty-five new studies were identified. Interventions covered were triage training (n = 7 studies), prehospital triage (n = 6), secondary triage (n = 2), transport/logistics (n = 3), decontamination (n = 5), and therapy (n = 2) during MCIs. Three new recommendations were developed. All achieved strong consensus.
Due to unsatisfactory evidence, recommendations could only be made on training for improving triage quality and regular exercises for testing a hospital's emergency response plan. No triage algorithm can be scientifically proven to be superior in all aspects. The key recommendation is the following: To improve triage quality, exercises or (virtual) training should be conducted in-house using verified triage systems and algorithms.
我们的目标是基于当前证据，为大规模伤亡事件（MCI）的管理制定基于证据和共识的建议。本指南主题是《德国严重/多发伤患者治疗指南》2022年更新的一部分。
对MEDLINE和Embase进行系统检索至2021年8月。从临床专家处获取更多文献报告。纳入随机对照试验、横断面研究、前瞻性队列研究和比较登记研究，前提是它们比较了分诊算法、MCI培训干预措施、后勤或运输、去污、院前和医院环境中MCI期间的诊断或治疗。我们考虑了与患者相关的临床结局，如死亡率、包括敏感性和特异性的诊断结局、分诊不足和分诊过度率以及资源使用情况。使用英国国家卫生与临床优化研究所（NICE）2012年清单评估偏倚风险。对证据进行叙述性综合，并利用专家共识制定建议并确定其强度。临床问题的人群、干预措施、对照和结局（PICO）问题由临床专家和指南方法学家提出。
在原始指南版本中我们筛选了321条记录，本次更新期间筛选了4225条。纳入了25项研究，均来自2009年至2021年的更新检索。确定了25项新研究。涵盖的干预措施包括MCI期间的分诊培训（n = 7项研究）、院前分诊（n = 6）、二次分诊（n = 2）、运输/后勤（n = 3）、去污（n = 5）和治疗（n = 2）。制定了三项新建议。所有建议均达成了强烈共识。
由于证据不充分，仅能就提高分诊质量的培训以及测试医院应急响应计划的定期演练提出建议。没有一种分诊算法能在所有方面被科学证明是 superior的。关键建议如下：为提高分诊质量，应使用经过验证的分诊系统和算法在内部进行演练或（虚拟）培训。
